589

Abstract

Introduction: In cardiopulmonary resuscitation (CPR), the emphasis has been on the restoration of a spontaneous pulse. While epinephrine achieves this goal, it has not been shown to significantly improve long-term outcome and has been linked with post-resuscitation myocardial dysfunction and reduced cerebral microcirculation. Little attention has been placed on the restoration of adequate perfusion and continued hemodynamic stability by the use of vasopressive agents. Hypothesis: This study will look at norepinephrine use in the immediate post-resuscitation period to achieve hemodynamic stability. Norepinephrine is a potent alpha-adrenergic agonist and causes a statistically and clinically significant increase in mean arterial pressure with minimal effect on heart rate or cardiac output. Norepinephrine infusion has been demonstrated to have significant benefits on blood pressure and mortality in humans with septic shock. In animals, it has been shown to delay cardiac arrest following hemorrhagic shock. Methods: We conducted retrospective case analysis to see whether norepinephrine infusion will affect the survival rate in in-hospital cardiac arrest. Clinical, demographic, and treatment data were collected in 90 hospitalized patients with cardiac arrest. Results: Of these patients, 77 had cardiac arrest due to either PEA or asystole (labeled non-VF arrest group). 13 patients had cardiac arrest due to either ventricular fibrillation or pulseless ventricular tachycardia (labeled VF arrest group). In the non-VF arrest group, 60 percent of the patients survived 24 h after CPR initiation. The survivors (N=46) were more likely to have received norepinephrine infusion than the non-survivors (34.8% vs 22.6%). Of those who had a prolonged arrest (more than ten minute down time, N=28) the survivors were also more likely to have received norepinephrine infusion (42.85% vs 25%). This trend, however, was not statistically significant. Conclusions: The results suggest that the addition of norepinephrine infusion to the current regimen might increase the number of 24-h survivors. Further larger studies are needed to evaluate the effectiveness including long term survival, feasibility and timing of norepinephrine infusion during CPR.